21 Complicationsof cervical total disc replacement (CTDR)Cervical total disc replacement (CTDR)complications ofComplications of Cervical Disc Replacement

2015 ◽  
Keyword(s):  
Total Disc Replacement ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Cervical Total Disc Replacement ◽  
Cervical Disc Replacement

The Feasibility of Optimal Surgical Result Prediction according to the Centre of Rotation Shift after Multilevel Cervical Total Disc Replacement

2018 ◽  
Vol 1 (2) ◽  
pp. 6
Author(s):  
Jun Ho Lee
Keyword(s):  
Rating Scale ◽  
Clinical Success ◽  
Total Disc Replacement ◽  
Numeric Rating Scale ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Consecutive Series ◽  
Cervical Total Disc Replacement ◽  
Successful Group ◽  
Centre Of Rotation

Objective: This study investigates the relation between shifted locations of centre of rotation (COR) at each cervical level and subsequent surgical outcomes after multilevel cervical total disc replacement (MCTDR) and identifies radiological parameter that corresponded to change of COR after MCTDR. Methods: The study included a consecutive series of 24 patients who were treated with MCTDR following diagnosis of multilevel cervical disc herniation or stenosis. Numeric rating scale (NRS), range of motion (ROM) at both C2-7 segment and TDR implanted levels, and the location of COR at TDR implanted level were evaluated at pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief.Results: The inherent CORs relatively at ventro-cranial coordinates have demonstrated significant migrations to dorso-caudal locations at each cervical levels, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 as well as MCTDR level after surgery in comparison with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the X-axis.Conclusions: The crucial determinants for clinical success after MCTDR, other than mere preservation of the ROM both at C2-7 and TDR implanted levels, was the restoration of COR from ventro-cranial location at degenerated cervical motion segment close to normal coordinates by posterior and inferior shifts after MCTDR. The position of COR along the X-axis after MCTDR was an important factor to determine maintenance of C2-7 RO.

scholarly journals Four-year results of a prospective single-arm study on 200 semi-constrained total cervical disc prostheses: clinical and radiographic outcome

2016 ◽  
Vol 25 (5) ◽  
pp. 556-565 ◽  
Author(s):  
Hans-Jörg Meisel ◽  
Lubomír Jurák ◽  
Jussi Antinheimo ◽  
Ricardo Arregui ◽  
Bernhard Bruchmann ◽  
...  
Keyword(s):  
Total Disc Replacement ◽  
Neck Disability Index ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Radiographic Outcome ◽  
Cervical Disc Replacement ◽  
Arm Pain ◽  
Facet Joint Degeneration

OBJECTIVE Recent studies have described encouraging outcomes after cervical total disc replacement (cTDR), but there are also critical debates regarding the long-term effects of heterotopic ossification (HO) and the prevalence of adjacent-level degeneration. The aim in this paper was to provide 4-year clinical and radiographic outcome results on the activ C disc prosthesis. METHODS A total of 200 subjects underwent single-level activ C (Aesculap AG) implantation between C-3 and C-7 for the treatment of symptomatic degenerative disc disease. Clinical and radiographic assessments were performed preoperatively, intraoperatively, at discharge, and again at 6 weeks, 6 months, 1 year, 2 years, and 4 years. Radiographic evaluations were done by an independent core laboratory using a specific software for quantitative motion analysis. RESULTS Neck Disability Index (NDI) and visual analog scale (VAS) score for neck and arm pain decreased significantly from baseline to the 4-year follow-up. The mean improvement for NDI was 20, for VAS severity and frequency of neck pain 26.4 and 28, and for VAS severity and frequency of arm pain 30.7 and 35.1, respectively. The neurological situation improved for the majority of patients (86.4%); 76.1% of cases were asymptomatic. Subsequent surgical interventions were reported in 7% of the cases, including device removals in 3%. In 2.5% a subsidence greater than 3 mm was recorded; 1 of these cases also had a migration greater than 3 mm. No device displacement, expulsion, disassembly, loose or fractured device, osteolysis, or facet joint degeneration at the index level was observed. Segmental lordotic alignment changed from −2.4° preoperatively to −6.2° at 4 years, and postoperative height was maintained during the follow-up. Advanced HO (Grade III and IV) was present in 27.1% of the cases; 82.4% showed segmental mobility. A progression of radiographic adjacent-segment degeneration occurred in 28.2%, but only 4.5% required surgical treatment. CONCLUSIONS The activ C is a safe and effective device for cervical disc replacement confirming the encouraging results after cTDR. Clinical trial registration no.: NCT02492724 (clinicaltrials.gov)

scholarly journals The Feasibility of Optimal Surgical Result Prediction according to the Center of Rotation Shift after Multilevel Cervical Total Disc Replacement

2020 ◽  
Vol 14 (4) ◽  
pp. 445-452
Author(s):  
Jung Hwan Lee ◽  
Jun Ho Lee
Keyword(s):  
Rating Scale ◽  
Clinical Success ◽  
Total Disc Replacement ◽  
Numeric Rating Scale ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Center Of Rotation ◽  
Cervical Total Disc Replacement ◽  
Successful Group ◽  
Cervical Kinematics

Study Design: Retrospective design/spine clinic and tertiary referral hospital.Purpose: This study investigated the association between shifted location of center of rotation (COR) and subsequent surgical outcomes and identified radiological parameters that corresponded to COR change after multilevel cervical total disc replacement (MCTDR).Overview of Literature: Cervical total disc replacement (TDR) maintains normal cervical kinematics after surgery. However, there is a paucity of literature analyzing the relationship between radiological shifts of COR and subsequent clinical success, especially when it comes to the issue of MCTDR switch.Methods: This study included 24 consecutive patients treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric rating scale, range of motion (ROM) at both C2–7 segment and TDR implanted levels, and location of COR at TDR level were evaluated pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief.Results: The inherent CORs relatively at ventrocranial coordinates demonstrated significant migrations to dorsocaudal location, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2–7 ROM and reduced angular improvement at C2–7 segment and MCTDR level compared with the successful group. Postoperative C2–7 ROM was related to postoperative COR along the x-axis.Conclusions: Aside from ROM preservation at both C2–7 and TDR levels, COR restoration from ventrocranial location close to normal coordinates by posterior and inferior shifts was marked as a clinical success after MCTDR. The COR position along the x-axis after MCTDR was an important factor to determine maintenance of C2–7 ROM.

scholarly journals Mid- to long-term rates of symptomatic adjacent-level disease requiring surgery after cervical total disc replacement compared with anterior cervical discectomy and fusion: a meta-analysis of prospective randomized clinical trials

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yifei Deng ◽  
Guangzhou Li ◽  
Hao Liu ◽  
Ying Hong ◽  
Yang Meng
Keyword(s):  
Anterior Cervical Fusion ◽  
Anterior Cervical Discectomy ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Cervical Fusion ◽  
Adjacent Level ◽  
Cervical Total Disc Replacement ◽  
Cervical Disc Replacement

Abstract Background Thus far, no meta-analysis focusing on the mid- to long-term incidence of adjacent segment disease requiring surgery after cervical total disc replacement and anterior cervical discectomy and fusion has been published yet. This study aimed to compare mid- to long-term rates of symptomatic adjacent-level disease requiring surgery after cervical disc replacement and anterior cervical fusion. Methods A meta-analysis was performed, and only randomized controlled trials with a follow-up period of more than 48 months reporting rates of symptomatic adjacent-level disease requiring surgery after cervical total disc replacement and anterior cervical discectomy and fusion were included. Results The analysis revealed that the overall rate of symptomatic adjacent-level disease requiring surgery in the cervical disc replacement group was significantly lower than that of the anterior cervical fusion group at 48–120 months’ follow-up. The subgroup analysis of different follow-up periods also yielded the same results. The rate of symptomatic adjacent-level disease requiring surgery in the cervical disc replacement group using unrestricted prosthesis was significantly lower than that of the anterior cervical fusion group (p < 0.001); however, the cervical disc replacement group using semi-restricted prosthesis showed no statistical difference compared with the fusion group. Conclusions Our review suggests that cervical disc replacement is preferable to anterior cervical fusion in reducing the incidence of symptomatic adjacent-level disease requiring surgery at mid- to long-term follow-up. A review of the literature also demonstrated that randomized controlled trials investigating the rate of symptomatic adjacent-level disease requiring surgery were insufficient; therefore, studies focusing on this subject with longer-term follow-up are warranted.

Effects of Removal of Uncinate Process in a Cervical Disc Replacement Model: A Finite Element Based Study

2007 ◽  
Author(s):  
A. Faizan ◽  
V. K. Goel ◽  
M. Krishna ◽  
T. Friesem
Keyword(s):  
Finite Element ◽  
Cervical Spine ◽  
General Procedure ◽  
Total Disc Replacement ◽  
Uncinate Process ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Fe Model ◽  
Disc Space ◽  
Cervical Disc Replacement

Anterior surgical approach is commonly used for Total Disc Replacement (TDR) surgeries in the cervical spine. The general procedure includes removal of the nucleus and anterior annulus of the intervertebral disc. Resection of Anterior Longitudinal Ligaments (ALL) is often performed to enter the disc space. The cervical spine also contains a unique anatomical feature called Luschka’s joints. These “joints” are actually fissures in the disc which run approximately parallel to the uncinate processes. These joints are thought to provide biomechanical stability to the cervical spine. However, sometimes surgeons have to sacrifice the uncinate processes at the involved level as well. We hypothesized that the cervical spine loses stability if the uncinate processes are removed along with disc replacement. We used a Finite Element (FE) model of cervical spine to prove the hypothesis (Fig1).

Early results after ProDisc-C cervical disc replacement

2005 ◽  
Vol 2 (4) ◽  
pp. 403-410 ◽  
Author(s):  
Rudolf Bertagnoli ◽  
James J. Yue ◽  
Frank Pfeiffer ◽  
Andrea Fenk-Mayer ◽  
James P. Lawrence ◽  
...  
Keyword(s):  
Cervical Spondylosis ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Definitive Treatment ◽  
Cervical Disc ◽  
Content Type ◽  
Cervical Disc Replacement ◽  
Arm Pain ◽  
Early Results ◽  
Fine Print

Object. Cervical anterior decompression and total-disc replacement is currently being investigated as an alternative treatment in patients with symptomatic intervertebral cervical spondylosis with and without radiculopathy. The authors prospectively investigated the safety and efficacy of using the ProDisc-C disc for cervical arthroplasty in the treatment of symptomatic cervical spondylosis. Methods. Sixteen patients in whom a diagnosis of symptomatic cervical spondylosis had been established were prospectively treated with complete anterior cervical discectomy and ProDisc-C cervical disc arthroplasty. Overall 12 single- and four two-level procedures were performed (20 prostheses). Patients underwent pre- and multiple postoperative assessments (3 and 6 weeks and 3, 6, and 12 months). The median age of all patients was 50 years (range 32–60 years). Levels of surgery included seven C5–6, six C6–7, and three C4–5. Neck and arm pain as well as disability scores were significantly improved by 3 months and remained significantly improved at 1 year. No additional fusion surgeries were necessary at the affected or unaffected levels. Radiography revealed an affected disc motion from 4 to 12°. No surgery- or device-related complications were documented. Conclusions. Analysis of preliminary results involving ProDisc-C arthroplasty indicates significant improvement in pain and functional outcome scores. No spontaneous fusions at the level of surgery or at adjacent levels were noted. Long-term follow-up studies will be necessary before more definitive treatment recommendations can be formulated.

scholarly journals Midterm osteolysis-induced aseptic failure of the M6-C™ cervical total disc replacement secondary to polyethylene wear debris

2022 ◽  
Author(s):  
Matthew Scott-Young ◽  
Evelyne Rathbone ◽  
Lauren Grierson
Keyword(s):  
Polyethylene Wear ◽  
Clinical Success ◽  
Total Disc Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
The Other ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Cervical Total Disc Replacement ◽  
Patient Reported

Abstract Background According to published meta-analyses, cervical total disc replacement (CTDR) seems to be superior to anterior cervical decompression and fusion (ACDF) in most clinical parameters. Despite short-term clinical success of CTDR, there are concerns regarding long-term durability of these prostheses. Methods This prospective study involved 382 patients who received standalone CTDR or a hybrid procedure (ACDF/CTDR). A retrospective comparison between different CTDR devices was conducted regarding patient-reported outcome measures (PROMs), failure scenarios, and revision surgeries. The M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) cohort was compared to the other CTDR devices clinically. Etiological reasons for revision, and the surgical technique of the revision was investigated. Results Fifty-three patients received M6-C CTDR. Eighteen patients (34%) were revised at an average of 67 months postoperatively for wear-induced osteolysis. There were three additional cases of pending revision. The PROMs of the two groups were similar, indicating that the failure mode (wear-induced osteolysis) is often asymptomatic. The demographics of the two groups were also similar, with more women undergoing revision surgery than men. There were three one-level CTDR, four two-level hybrids, seven three-level hybrids, and three four-level hybrids revised anteriorly. Sixteen patients underwent removal of the prosthesis and were treated according to the extent of osteolysis. There were four vertebrectomies, six revisions to ACDF, and six revisions to another CTDR. One patient underwent supplemental fixation using a posterior approach. The other CTDR cohort had an incidence of 3.3% at the equivalent time, and none of these were due to osteolysis or wear-related events. Conclusions There is a concerning midterm failure rate related to ultra-high-molecular-weight-polyethylene wear-induced osteolysis in the M6-C. Patients implanted with the M6-C prosthesis should be contacted, informed, and clinically and radiologically assessed.

scholarly journals Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial

2016 ◽  
Vol 25 (2) ◽  
pp. 213-224 ◽  
Author(s):  
Kris Radcliff ◽  
Domagoj Coric ◽  
Todd Albert
Keyword(s):  
Clinical Trial ◽  
Outcome Measures ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Adverse Event Rate ◽  
Cervical Disc ◽  
Long Term Outcome ◽  
Cervical Total Disc Replacement ◽  
Investigational Device Exemption ◽  
Disease Specific

OBJECTIVE The purpose of this study was to report the outcome of a study of 2-level cervical total disc replacement (Mobi-C) versus anterior cervical discectomy and fusion (ACDF). Although the long-term outcome of single-level disc replacement has been extensively described, there have not been previous reports of the 5-year outcome of 2-level cervical disc replacement. METHODS This study reports the 5-year results of a prospective, randomized US FDA investigational device exemption (IDE) study conducted at 24 centers in patients with 2-level, contiguous, cervical spondylosis. Clinical outcomes at up to 60 months were evaluated, including validated outcome measures, incidence of reoperation, and adverse events. The complete study data and methodology were critically reviewed by 3 independent surgeon authors without affiliation with the IDE study or financial or institutional bias toward the study sponsor. RESULTS A total of 225 patients received the Mobi-C cervical total disc replacement device and 105 patients received ACDF. The Mobi-C and ACDF follow-up rates were 90.7% and 86.7%, respectively (p = 0.39), at 60 months. There was significant improvement in all outcome scores relative to baseline at all time points. The Mobi-C patients had significantly more improvement than ACDF patients in terms of Neck Disability Index score, SF-12 Physical Component Summary, and overall satisfaction with treatment at 60 months. The reoperation rate was significantly lower with Mobi-C (4%) versus ACDF (16%). There were no significant differences in the adverse event rate between groups. CONCLUSIONS Both cervical total disc replacement and ACDF significantly improved general and disease-specific measures compared with baseline. However, there was significantly greater improvement in general and disease-specific outcome measures and a lower rate of reoperation in the 2-level disc replacement patients versus ACDF control patients. Clinical trial registration no. NCT00389597 (clinicaltrials.gov)

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